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ISSN : 2349 – 1604 (Volume – 3, No. 1, January 2016) Research article
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Determinant of Environmental Disease in Health Promotion of
Community Lead Total Sanitation (CLTS) on Elementary Students
as Primary Prevention in Isolated District, Indonesia
Linda Suwarni1, Selviana1, Helman Fachrie2
1. Departement of Public Health Science, University Muhammadiyah of Pontianak, Indonesia
2. Departement of Economy, University Muhammadiyah of Pontianak, Indonesia
Corresponding Author : Linda Suwarni, Address: A. Yani Street 111, Pontianak, Indonesia
Manuscript received: 08.11.15
Manuscript accepted: 12.12.15
Abstract
West Kalimantan was called “a thousand rivers, that many place in isolated area. Discoveries
that emerging and re-emerging pathogens have their origin in environmental change has created
an urgent need to understand how these environmental changes impact disease burden.
Prevalence of environmental based disease is high enough in this area. The aimed of this
research was to identify determinants factors of environmental disease in isolated area of West
Kalimantan in Health promotion effort of Community Lead Total Sanitation (CLTS) as primary
prevention at elementary school students in 2015. The method used quantitative research with
cross sectional approach and total sampling at elementary students (80 students at third, fourth,
and fifth grades in Isolated
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District). The results showed that the significant determinant of environmental disease are:
knowledge (p value = 0.000), attitude (p value = 0.000), the practice of Clean and Healthy
Behavior (p value = 0.005), and latrine ownership (p value = 0.000). Knowledge, attitudes, and
practices of PHBS are protective factors that can prevent environmentally based disease
incidence (OR <1). Based on the results of this study, media favored by elementary students are
comic, and short movie. School children are the future generation and potentially trigger to apply
Community Lead Total Sanitation (CLTS). They are also as agents of change in a family
environment, so as to stimulate the family to apply CLTS in particularly, and society in
generally. Therefore, health promotion CLTS required for elementary students as agents of
change so as to reduce the incidence of environmental disease through the comic and the movie
according to the needs. In addition, the need for cooperation with local governments in the
provision of public facilities and infrastructure in communities in isolated district.
Keywords:
Sanitation, Health Promotion, Community Lead Total Sanitation (CLTS),
Environmental Disease, Primary Prevention
Introduction
Public health scientists are increasingly discovering that the recent emergence or reemergence of infectious diseases has an origin in environmental change [1,2]. These
environmental changes encompass social processes such as urbanization and creation of
transportation infrastructure, as well as ecologic [3].
West Borneo is one of the provinces which has a lot of isolated district. It is due to the
fact that West Borneo (West Kalimantan) is surrounded by rivers (well-known as ‘thousands of
river’. Therefore, reaching the district is not easy. The prevalence of environmental disease is
sufficiently high in these isolated district, like: diarrhea, malaria, ISPA, dengue fever,
tuberculosis, dermatological disease, and worm infestation (especially found in school year
children). People in these district have minimum access to health information and adequate
facilities and infrastructures. Besides, low level of social and economy status is another reason
which deteriorates this problem.
Human behaviors and their surroundings are highly influence in this environmental
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disease problem [3]. Epidemiology studies show the correlation between determinant of
environmental and diseases, so that identification of those risk factors is needed [4]. The
previous studies which were conducted by Kumar and Harada (2002) show that sanitation and
significant air pollution are pertained to these diseases; typhus, diarrhea, and malaria. These
things are positively correlated with water consumption pattern and poverty (including unhealthy
house environment and social economy situation of the families) [5]. In addition, air pollution is
also the infection factor of the environment-based disease [6]. This disease can be prevented by
creating health environment and behavior [7].
Community-Led total sanitation (CLTS) offers a new, peoplecentric approach
conceptually grounded in participatory development. But despite its broad appeal, the CLTS
policy narrative has become equated with quick results, low-cost, provocative language and the
potential for community self-help [8]. Bulaya et al. (2014) revealed that CLTS as a control
measure did not significantly improve T. solium infections in pigs. The research also revealed
that the sanitation practices and awareness of cysticercosis did not change. It is recommended
that a longer term evaluation be undertaken when the villages have been declared open
defaecation free [9]. Health education, as one of an essential component of prevention and
control programmes for environmental disease. One of the possible control measures is the
improvement of basic sanitation, hygiene and health education, which has proved to be an
efficient strategy for many parasitic and infectious disease transmitted by faeces [10].
The aimed of this research was to know the determinant of environmental disease in
isolated district to promote Community-Lead Total Sanitation (CLTS) on Elementary Students
as Primary Prevention.
Materials and Methods
The method used quantitative research with cross sectional approach and total sampling
at elementary students (80 students at third, fourth, and fifth grades in Sepuk Laut District). This
research was conducted on March-June 2015.
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The instrument for data collection was questionnaire which was obtained from various
literatures. Questions were developed in English and were translated into Indonesia by an expert
translator. Before the questionnaire was used, research instrument test was conducted to know
the validity and realibility of the instrument. It was used 30 respondent that had similar
characteristic with respondent in this research. The result showed that all of the item
questionnaire was valid and reliable (r > 0,3 and alpha cronbach > 0,7).
Data collection was conducted by having interview with respondents. Analyzing data was
used Chi-Square tests.
Results and Discussions
Here is the result of univariat analysis of 80 respondents in this research:
Table 1. Univariat Analysis
No
1.
2.
3.
4.
5.
Variable
N
%
Not good
30
37,5
Good
50
62,5
Not supportive
38
47,5
Supportive
42
52,5
Not good
46
57,5
Good
34
42,5
Yes
60
75,0
No
20
25,0
Yes
62
77,5
No
18
22,5
Knowledge
Behavior
Health and clean lifestyle
Possession of lavatories
Environmental disease
Source: Primary data, 2005.
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The table above showed that the respondents’ knowledge was bad (37.5%), unsupportive
behavior (47.5%), bad clean and health lifestyle (57.5%), those who do not possess lavatories
(75.0%), and got environment-based disease within 6 months (77.5%).
The result of bivariate analysis can be seen in the following table:
Table 2. Result of bivariat analysis with Chi-Square Test
The occurrence of environment-based disease
No
Variable
p value
PR
95%
Confidence Interval
1.
Knowledge
0,0001
0,486
0,330 – 0,716
2.
Behavior
0,0001
0,608
0,460 – 0,804
3.
Health and clean lifestyle
0,005
0,693
0,552 – 0,870
4.
Latrines
0,0001
3,800
1,775 – 8,136
Source: Data Analysis by using SPSS, 2005.
Knowledge is a protective factor in environment-based disease cases. The result of this
research showed that “good knowledge” about sanitation and clean and healthy lifestyle could
prevent 2,06 times someone from having environment-based disease compared to those who lack
of knowledge. In contrast, Williams (2009) revealed that there was significant correlation
between knowledge and waterborne disease [11]. This knowledge is influenced by education. In
addition, the previous research showed that low level of education more likely to have minimum
of knowledge. Therefore, it would influence the occurrence of diseases (including diarrhea)
[12],[13]. Moreover, the research was conducted in Zimbabwe, showed that knowledge about
sanitation and contagion had positive behaviour in prevention of waterborne disease [14].
As well as knowledge, Behaviour is a protective factor in environment-based desease.
This research showed that positive’s behaviour regarding sanitation could prevent 1,6 times
environment-based disease compared to those who are not positive. The negative behavior about
sanitation are more likely potential having environment-based disease (including waterborne
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disease) [15]. According to previously survey, healthy lifestyle would impact on human health
status [16-17]. Positive behavior needs to be nurtured in order to create positive actions. Positive
action could prevent the dehydration of diarrhea [18].
Clean and Healthy Behavior (PHBS) is also the protective factor in the occurrence of
environmental disease. This research showed that the healthy and clean lifestyle could prevent
environment-based disease 1,4 times. These healthy and clean lifestyles are influenced by
knowledge and practice of Clean and Healthy Behavior. The result of this research shows that
there is a significant relation between knowledge (p value = 0,004 and OR = 5, 091; 95%CI =
1,773 – 14,615) and behavior (p value = 0,035 and OR = 2,971;95%CI = 1,175-7,514). Green
theory stated that behavior is influenced by predisposing factors which are knowledge and
behavior. These behaviors and knowledge will form or lead the realization of certain attitude.
Children is a potential target group of PHBS promotion, especially on elementary school
children. They have active in playing with soils (the medium of the disease infection). PHBS
program at elementary school children could be started with simple thing such as washing hands
by using soaps, brushing teeth, and cleaning their nail and hair. These activities can help reduce
the risks of the occurrence of diseases, such as diarrhea and worm infestation which frequently
attacks school age children (6-12 years old that is actually related to PHBS).
Hand hygiene has been shown to reduce the incidence of respiratory and gastrointestinal
infections [19]. Despite its simple, cost-effective nature, adequate hand washing is rarely
practiced [20].
The possession of lavatory was risk factor of the occurrence of environment-based
disease (PR > 1). Respondents who do not have lavatory or water closet more likely get infected
by environmental disease 3,8 times compared to those who have lavatory. The supply of lavatory
facilities is a part of important sanitation efforts. Viewed from health perspective, feces and
waste can pollute the environment particularly soil and water source. Using of latrines as health
behavior enabling factor is the most dominant determinant in using water closet. Availability of
latrine was one of health’s family facilities enables the family members to use latrines as
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facilities to defecate [21].
Faeces were considered disease-causing agents; notions of ‘‘proper hygiene” emphasised
latrine use, that faeces were not to be used to fertilise crops and that latrines had to be
constructed away from homes to avoid ‘‘bad odours.” In agreement with Green (1999) cit
Bardosh (2015), local aetiologies of sanitation-related diseases (cholera, bilharzia, soiltransmitted helminths, porcine cysticercosis and diarrheal diseases) followed naturalist
perspectives through food, water, air, insects and animals [8]. Their health and livelihood
impacts were well appreciated; 64% of families in my household questionnaire reported at least
one member with severe diarrhoea and 11% with intestinal worms within the last six months,
equivalent to a recent parasitological survey in Katete [22]. Some diseases which can be spread
out by human’s feces such as; typhus, dysentery, cholera, various of worms (pinworms, bracelet
worms, ribbon worms), schistosomiasis etc. To prevent the contamination of feces to
environment, human’s defecation disposal must be managed well. Defecation must be in certain
places or healthy water closet.
Open defecation, both symbolically and practically, represented an embedded
marginalisation from the modern Zambian state where multiple barriers to latrine construction
coexisted in the context of fragile livelihoods. In such agrarian communities, CLTS cannot be
conceptualised as a blanket approach quickly bringing total sanitation to the masses. For its
strengths to be realised in contexts of rural poverty, a targeted strategy that builds local
institutional capacity and iteratively scales-up over time is needed [8]. Miko et al. (2013)
revealed that more women than men reported consistent hand washing before preparing food (p
= .002) and after using the toilet (p = .001) [23].
Conclusion
Determinant of environmental diseases in this study (at elementary school students) are
knowledge about sanitation and healthy and clean lifestyle, behavior towards sanitation, healthy
and clean lifestyle, and possession of lavatory. Health education is needed to increase
knowledge, behavior, and healthy and clean lifestyle of people in isolated district, so that it can
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prevent the occurrence of environmental disease. It is needed to have intervention as primary
prevention on elementary school students to promote their knowledge and behavior regarding
sanitation and healhty life style.
Acknowledgement
Thanks to Technology and Research Department, and Research Directorate Education
and People’s Dedication who have granted this research funding. Thanks to all people who
participated in this research, people in Sepuk Laut district, West Borneo, Indonesia.
References
[1]
McMichael AJ and Martens P (2002) Environmental Change, Climate and Health: Issues
and Research Methods. Cambridge, UK: Cambridge University Press.
[2]
Patz JA, Daszak P, Tabor GM, Aguirre AA, Pearl M, Epstein J, et al. (2004) Unhealthy
landscapes: policy recommendations on land use change and infectious disease
emergence. Environ Health Perspect. 112, 1092–1098.
[3]
Eisenberg, JNS, Desai, MA., Levy, K., Bates, SJ. et al. (2007) Environmental Determinats
of Infectious Disease: A Framework for Tracking Causal Links and Guiding Public Health
Research. Environmental Health Perspectives. 115 (8), 1216 – 1223.
[4]
Lotus, EV (2004) Epidemiology of Inflammatory Bowel Disease: Incidence, Prevalence,
and Environmental Influence. American Gastroenterogical Association. 126 (6), 1504-1571.
[5]
Kumar K and Harada, H (2002) Field survey on water supply, sanitation and associated
health impacts in urban poor communities, a case from Mumbay City, India. Water Science
and Technology. 46, 269-275.
[6]
Nicas, M., Nazaroff, WW and Hubhard, A (2005) Toward Understanding the Risk at
Secondary Airborne Infection: Emission of Respirable Pathogens. Journal Occupational and
Environmental Hygiene. 2 (3), 143-154.
[7]
WHO (2006) Global estimates of burden disease caused by the environment and
occupational risks.
[8]
Bardosh, K (2015) Achieving ‘‘Total Sanitation” in Rural African Geographies: Poverty,
Participation and Pit Latrines in Eastern Zambia. Geoforum. 66, 53-63.
359
SMU Medical Journal, Volume – 3, No. – 1, January, 2016
[9]
Bulaya, C, Mwape, KE., Michelo, C., Sikasunge, CS. et al.(2015) Preliminary evaluation of
Community-Led Total Sanitation for the control of Taenia solium cysticercosis in Katete
District of Zambia. Veterinary Parasitology. 207, 241-248.
[10] Fleury, a., sciutto, e., aluja, a., larralde, c., et al. (2013) Control of taenia solium tranmission
of taeniosis and cysticercosis in endemic coutries: the roles of continental networks of
specialists and of local health authorities.
[11] Williams, A. (2009) Water Quality and Waterborne Disease along the Niger River, Mali: A
Study of Local Knowledge and Response". Theses, Dissertations, Professional Papers. Paper
1174.
[12] Balk, D., Pullum, T., Storeygard, A., Greenwell, F and Neuman, M (2003) Spatial analysis
of childhood mortality in West Africa. Population, Space, and Place. 10(33), 175-216.
[13] Agha, S (2000) The determinants of infant mortality in Pakistan. Social Science and
Medicine. 51(2), 199-208.
[14] de Zoysa, L., Carson, D., Reachem, R., Kirkwood, B., Lindsay-Smith, E and Loeweson, R.
(1984) Perceptions of childhood diarrhea and its treatment in rural Zimbabwe. Social
Science and Medicine. 19 (7), 727-734.
[15] Sibiya, JE and Gumbo, JR (2013) Knowledge, Attitude and Practices (KAP) Survey on
Water, Sanitation and Hygiene in Selected Schools in Vhembe District, Limpopo, South
Africa. Int. J. Environ. Res. Public Health. 10, 2282-2295.
[16] Uniceft (2012) School Water, Sanitation and Hygiene: Knowledge, Attitudes and Practices
Survey.
[17] WASH-Alek Base (2012) Knowledge, Attitude, and Practice Survey Report Gogrial West
Country, Warrap State South Sudan. ACF USA South Sudan Mission.
[18] Rauf, H., Adhiwijaya, A and Hasanudin, N (2013) Association of knowledge, attitude, and
behavior with diarrhea on child (1-5th) in Takalar District. Health science diagnosis journal.
2(6), 44-52.
[19] Aiello, AE, Coulborn RM, Perez, V and Larson, EL (2008) Effect of Hand Hygiene on
Infectious Disease Risk in the Community Setting: A Meta-Analysis. Am J Pub Health. 98,
1372–1381.
[20] Judah G, Aunger R, Schmidt WP, Michie S, Granger S, et al. (2009) Experimental pretesting
of hand-washing interventions in a natural setting. Am J Pub Health. 99, S405–411.
360
SMU Medical Journal, Volume – 3, No. – 1, January, 2016
[21] Pane, E (2009) Influence of family behavior of using latrine. National Public Health Journal.
3(5).
[22] Mwape, KE, Phiri, IK, Praet, N., Muma, JB, Zulu, G., et al. (2012) Taenia solium infections
in a Rural Area of Eastern Zambia – a community based study. PLoS Negl. Trop. Dis. 6 (3),
e1594 http://dx.doi.org/10.1371/journal.pntd.0001594.
[23] Miko, BA, Cohen B., Haxall K., Conway L., Kelly, N., et al. (2011) Personal and Household
Hygiene, Environmental Contamination, and Health in Undergraduate Residence Halls in
New York City, 2011. PLoS ONE. 8(11): e81460.
Authors Column
Linda suwarni is a lecturer (Health promotion, reproductive health,
and HIV AIDS ) in University Muhammadiyah of Pontianak since
2006 until now.
She is a consellour of HIV AIDS in 2007. In 2012 until now, she is
as a chief of Data and Health Study Center at University
Muhammadiyah of Pontianak. She is studying at Gadjah Mada
University, Yogyakarta, Indonesia.
SMU Medical Journal, Volume – 3, No. – 1, January, 2016, PP. 352-361
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